Traumatic dislocation of the first rib: A case report and review of the literature

Stoddart, Stephanie S.; Handy, Michael; Cleland, Perry; Wall, Daryl R.; Brown, Anthony

doi:10.1111/1742-6723.12866

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…The anatomical location of the first rib determines that significant dislocation could result in injuries of subclavian vessels, trunks of the brachial plexus, cervicothoracic ganglion, and trachea [7]. The first rib is not commonly dislocated in trauma because its articulations at the T1 vertebra and the manubrium are stabilized by strong ligaments [8].…”

Section: Introductionmentioning

confidence: 99%

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Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review

et al. 2019

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Background Tracheobronchial lacerations from trauma can be life-threatening and present significant challenges for safe anesthetic management. Early recognition of tracheal injuries and prompt airway control can be lifesaving. Case presentation A 56-year-old man with no significant medical history presented with difficulty breathing after a blunt trauma to his chest to the emergency room and was diagnosed with dislocation of the first rib and tracheal laceration after a chest tomography (CT) study. Subcutaneous emphysema in neck area quickly worsened indicating continuous air leak. Emergent surgical repair was scheduled. General anesthesia with maintaining spontaneous ventilation was performed and a 5.5 mm endotracheal tube was placed under the guidance of flexible bronchoscopy. Depth of anesthesia was maintained to achieve a Bispectral Index Score of 40–60. Once the offending first rib was removed, a 7.5 mm endotracheal tube was inserted distal to the laceration site with the guidance of flexible bronchoscopy. Once confirmed location of the endotracheal tube, cisatracurium was administered intravenously and the patient was managed on mechanical ventilation with interval positive pressure ventilation. The operation was successful and he was transferred to the ICU intubated. He then received elective surgical repairs for sternum fracture, multiple rib fractures and hemopneumothorax under general anesthesia on day 5 after the first surgery and was extubated on postoperative day 7. The subsequent course was uneventful. Comprehensive rehabilitation was done for 2 weeks and he was discharged home on postoperative day 41. Conclusions Early diagnosis and multidisciplinary collaborations are keys to the successful management of this patient. Flexible bronchoscopy is particularly useful in airway management for urgent trachea tracheal laceration repair.

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Section: Introductionmentioning

confidence: 99%

“…The first rib is not commonly dislocated in trauma because its articulations at the T1 vertebra and the manubrium are stabilized by strong ligaments [8]. In rare cases, traumatic first rib dislocations could injure subclavian artery, cervicothoracic ganglion, brachial plexus and trachea [7].…”

Section: Introductionmentioning

confidence: 99%

Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review

et al. 2019

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“…Osteopathic therapy that mobilizes and pushes the first rib in the caudal direction is a standard therapy. 3 In this patient however, the rib would need to be "grabbed" and pulled upward which would likely require general anesthesia for the patient to tolerate and to achieve adequate muscle relaxation. Surgical rib removal could also be…”

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confidence: 99%

“Cervicalgia: Check Your First Rib”

et al. 2021

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Left fourth and sixth costovertebral dislocation abutting the aorta

et al. 2023

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While rib fractures are common in blunt thoracic trauma, dislocations of the costovertebral joints (CVJs) are extremely rare and typically involve the first, eleventh, or twelfth rib. We report a rare case of dislocation of the left fourth and sixth CVJs in a 36-year-old man who was run over by a car. The rib heads were displaced anteriorly, abutting the aorta. Additional injuries included bilateral hemopneumothoraces, pneumomediastinum, pulmonary contusions, grade 3 splenic injury, left adrenal hematoma, retroperitoneal hematoma, Morel-Lavallée lesions at bilateral hips, and multiple fractures, including at the ribs and pelvis. There was also a fracture of the fourth thoracic vertebral body, which was occult on initial CT, but seen on subsequent CTs. The CVJ dislocations were managed conservatively, without short-term complications. Prompt surgical intervention has been recommended in cases where sharp rib fracture fragments are displaced close to the aorta to prevent fatal aortic injuries. However, there is a literature gap on the management of rib heads that are dislocated against the aorta. Our experience suggests that conservative management may be acceptable in some of these cases. This case report aims to increase radiologists’ awareness of CVJ injuries, which are important for thoracic spine stability, and highlights the association between CVJ dislocations and spinal injuries.

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Traumatic dislocation of the first rib: A case report and review of the literature

Cited by 4 publications

References 7 publications

Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review

Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review

“Cervicalgia: Check Your First Rib”

Left fourth and sixth costovertebral dislocation abutting the aorta

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